Key result
PAWP/CO slope was significantly associated with increased all-cause mortality risk (adjusted HR 1.10; 95% CI 1.02-1.18; p=0.019), whereas peak PAWP was not (HR 1.0; p=0.870).
Why the study?
Peak PAWP >= 25mmHg and PAWP/CO slope > 2mmHg/L/min are suggested to uncover HFpEF during exercise, prompting a comparison of their prognostic and clinical relevance in patients with unclear dyspnea on effort without overt cardiopulmonary disease.
Does the pulmonary arterial wedge pressure to cardiac output (PAWP/CO) slope better predict all-cause mortality and clinical HFpEF probability compared to peak PAWP in patients with unclear dyspnea on effort?
Cohort (n=680)
Yes
Does the pulmonary arterial wedge pressure to cardiac output (PAWP/CO) slope better predict all-cause mortality and clinical HFpEF probability compared to peak PAWP in patients with unclear dyspnea on effort?
In patients with unexplained exertional dyspnea, the exercise PAWP/CO slope predicts all-cause mortality and correlates better with clinical HFpEF probability than peak PAWP, supporting its superior diagnostic and prognostic value during invasive exercise hemodynamic testing.
Answers are grounded in this paper and cite their sources.
May inform mortality risk stratification in unexplained dyspnea; leaves open prospective validation of PAWP/CO slope over peak PAWP.
Background Peak pulmonary arterial wedge pressure (PAWP) ≥ 25mmHg and PAWP/cardiac output (CO) slope > 2mmHg/L/min have been suggested to describe an abnormal increase in left ventricular filling pressures during exercise and uncover heart failure with preserved ejection fraction (HFpEF). We aimed to compare the prognostic and clinical relevance of PAWP/CO slope to peak PAWP in patients with unclear dyspnea on effort without overt cardiopulmonary disease. Methods We analyzed the data of patients from the Pulmonary Hemodynamics during Exercise Network (PEX-NET), a large, multi-center research collaboration. All patients underwent resting and exercise right heart catheterization in the same body position and had a resting mean pulmonary arterial pressure < 25mmHg. We analyzed associations with all-cause mortality using spline curves, Kaplan-Meier and Cox-Regression analysis. Associations between pulmonary hemodynamics and clinical H2FpEF and HFpEF-ABA Scores were done using group comparisons and using a 2x2 contingency table. Results We included 680 patients from 14 centers (median age 58 [IQR 45-68] years, 65% women, HFpEF-ABA score 0.45 [0.23-0.66], follow-up 7.0 [4.4 - 10.9] years). The PAWP/CO slope was significantly associated with increased mortality risk, even after adjusting for age, sex, hemoglobin and resting hemodynamics (HR 1.10, 95%CI: 1.02-1.18, p = 0.019; Figure 1B. A PAWP/CO > 2mmHg/L/min was also associated with increased mortality (p = 0.032; Figure 1D). Peak PAWP, however, was not associated with mortality, neither as continuous variable (HR 1.0, 95%CI: 0.97-1.03, p = 0.870; Figure 1A) nor dichotomized at 25mmHg (HR 0.75, 95%CI: 0.43-1.30, p = 0.301; Figure 1C). The sensitivity and specificity for PAWP/CO slope > 2mmHg/L/min vs. peak PAWP ≥ 25mmHg to detect high HFpEF probability (HFpEF-ABA Score > 0.75) were 60% and 65% vs. 28% and 82%, respectively. A PAWP/CO slope > 2mmHg/L/min in the presence of peak PAWP < 25mmHg was frequent (23.4% of subjects) and was characterized by an increased HFpEF probability (HFpEF-ABA Score: 0.56 [0.36-0.77]). Conclusion In this multi-center study, an elevated PAWP/CO slope was significantly associated with increased mortality risk and elevated HFpEF scores in patients undergoing evaluation for unclear dyspnea on effort without established cardiopulmonary disease and overall only moderate HFpEF probability. Elevated peak PAWP was not associated with mortality and had low sensitivity to detect HFpEF clinically in these patients. Overall, the PAWP/CO slope may better reflect an abnormal response of the left ventricle during exercise as compared to a peak PAWP threshold.
No takes yet. Share an insight, caveat, or question.
Zeder et al. (2026) conducted a cohort in Unclear dyspnea on effort without overt cardiopulmonary disease (n=680). Pulmonary arterial wedge pressure to cardiac output (PAWP/CO) slope vs. Peak pulmonary arterial wedge pressure (PAWP) was evaluated on All-cause mortality (HR 1.10, 95% CI 1.02-1.18, p=0.019). PAWP/CO slope was significantly associated with increased all-cause mortality risk (adjusted HR 1.10; 95% CI 1.02-1.18; p=0.019), whereas peak PAWP was not (HR 1.0; p=0.870).
Synapse has enriched 10 related papers. Consider them for comparative context: